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Norwich Bulletin - 6/19/2005

Vestibular Disease

A friend of mine called me in a panic last month, absolutely sure that her beloved thirteen year old cat had suffered some sort of a stroke. She was stumbling around the house, going in circles with her head tilted to one side. Her eyes were not working right and she was falling on her side when trying to get up on the couch. Although the symptoms were not completely right to have been a stroke, it was the only thing we could think of.

A trip to the vet came up with very little. The only thing they were certain of was that is was not a stroke. However, it looked like it could be something called Feline Vestibular Disease. And so a search on the internet brought me the information that I can now share with my readers.

To understand what the disease is, one must know what the vestibular system actually does. This system helps a body know if it is properly oriented in relation to the earth. It tells us if we standing upright or falling and it is directly responsible for informing the eyes, hands and legs on how to move. It keeps us from falling, allows us to navigate uneven terrain and it gives us the ability to focus on moving objects without becoming dizzy and nauseous. In essence, it keeps our equilibrium steady.

There are two sets of receptors located in the middle ear, which detects tumbling and turning and lets us know if we are upside down or rightside up. When you move your head from side to side, tiny hair cells move through the ear canals that carry the message to the part of the brain which controls locomotion.

Then instructions are carried through the nerves that tell the muscles needed to keep us on solid ground and moving in the right direction. If there is an abnormal flow in the inner ear or any type of inflammation, vestibular syndrome can strike.

The most common form of vestibular disease in dogs and cats is called Idiopathic, which simply means that we don't really know why it happens. It just does - a sudden onset of the disease, basically out of nowhere, can hit our older dogs and cats (and some younger ones too, although not as often).

And while most cases will resolve itself as quickly as it started, sometimes there will be a persistent head tilt or some other type of directional challenge. Full recovery is often realized within two weeks, but can take as long as six weeks and in extreme cases, months. It is very difficult to make an absolute diagnosis in your animal though - unless you can afford a CAT scan or MRI, which few pet owners can justify in their budget.

The treatment for vestibular disease is pretty much TLC, unless the dog or cat requires rehydrationwith intravenous fluids. Sometimes the animal cannot even hold its head up long enough to eat and needs someone to hold their head steady while they eat or drink during the first few days. In cases of severe disorientation, a veterinarian might prescribe a sedative so that the animal will not move around too much during the first few days.

If the vestibular disease was thought to be derived from a middle ear infection, an antibiotic would also need to be part of the treatment.

While the initial signs of vestibular disease can be alarming and the animal incapacitated, complete recovery can usually be expected. However, there are always exceptions to every rule.

There are other reasons for the onset of vestibular disease - but expensive tests are needed to make a proper diagnosis. Brain tumors can be a cause, especially if the cat or dog seems to be "one sided." Also, a middle ear infection, which may not show up in a routine examination, can also cause the symptoms.

Being able to image the brain tissue itself through an MRI, allows brain abnormalities to be evaluated. If these tests can be afforded, there are medications that can help shrink a brain tumor or antibiotics to clear up a middle ear infection - but if not, then it is more or less a trial by error on the part of the treating veterinarian.

All of us have had times when our equilibrium has been a little off and we have felt dizzy or disoriented. This is what happens to our older animals when they develop vestibular disease.

The best that most of us can do when this happens, because of the expense of the testing, is to have our vet treat our pet symptomatically and hope that the treatment will be successful. The prognosis for my friend's cat is good, but there are no guarantees that she will recover 100% since she could not afford the MRI and proper treatment at this point is only a guess.

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